Tuesday, May 19, 2009

Well-meaning but misguided

As we move along our parenting journey, I realize how important it is for every nursing mother and baby to have a pediatrician who is not just supportive of breastfeeding, but thoroughly educated about it - and unfortunately, they seem to be rare.

Back in university, I only had one course dedicated to infant nutrition, which emphasized the importance of breastfeeding but didn't cover many important details such as supply and demand, possibility of poor latch, overactive letdown, distracted nursing, and many other common issues breastfeeding mothers often have to deal with. I know that in medical schools, more often than not even less is learned about this wonderful, God-given way of feeding babies.

Most pediatricians today tell mothers they should nurse their babies - if everything goes smoothly, if no problems arise, and if the baby is gaining weight strictly according to age-appropriate charts. From stories of fellow mothers, many pediatricians have only a vague concept that breasts make milk, and have all too many misconceptions, such as:

* It's very common to have inadequate milk supply.* A mother's milk supply can dry up for no reason and it's normal; it isn't worth the trouble to check why this happens.* Whatever a mother does or doesn't do, it doesn't affect her milk supply and therefore it's pointless to try and improve it.* Each baby needs to eat at such-and-such intervals, and weight gain should be such-and-such number each week.* Weighing a baby before and after a feeding is a good way to assess how much food the baby gets throughout the day, because the amount of milk a baby gets per nursing session is the same every time.

I'm not saying pediatricians have no clue. They certainly have lots of knowledge, and their advice and opinion regarding a child's health should be taken most seriously. But - and this is a serious but - don't be overwhelmed by someone's authority just because he is a doctor. Western medicine often has an impatient, quick-fix attitude, which is good for acute conditions, but many times displays little knowledge and much arrogance towards treatment of anything that has to do with chronic illnesses, allergies, and nutrition.

In certain areas, nurses tend to know more than doctors; or less. I had a nurse tell me that even if breastfeeding is going well, it's recommended to supplement with formula starting from four months.

Many medical professionals have an attitude that can be described as well-meaning but misguided. Be careful.

This is so very true and so sad at the same time. You would think doctors would keep up with educating themselves about breastfeeding. I have mostly educated myself about the issue. I knew that I could not go to my childrens old pediatrician about it and our new one is more pro breastfeeding.

This is so true. I was caring for a newborn in my church nursery the other day, and the young mom nursed her baby before she left. Then, she left me with a bottle of formula and told me to give it to the baby after a period of time. She then told me that her pediatrician had told her to supplement with formula at least once every two weeks to "prepare for the possibility that something might go wrong with breastfeeding and the baby will already be accustomed to formula." She then expressed frustration that her milk supply was so large, but she felt like she needed to do what her doctor said.

Later, after I gave her baby the formula, the poor baby threw up continually for the next hour. It got so bad that she was vomiting bile. When the mom came back to pick up her baby, she expressed more frustration that she must try other formulas until she found one that "agreed" with her little one. She never questioned the doctor's recommendation.

I, too, believe that many doctors and nurses are not completely educated about things like nutrition and breastfeeding. The exception would be the nurses at our local hospitals who specialize in breastfeeding and help train new mothers. However, when new mommies leave the hospital that resource is gone and most women will receive ongoing recommendations from pediatricians.

Thanks for bringing this information to light. I hope that it will encourage mommies who are having trouble with breastfeeding to seek information and do research instead of just blindly accepting the advice of a well-meaning pediatrician.

My mother is still angry that when I was born the doctor told her that formula was vastly preferable to breast milk. Then, several months later, another doctor chastised her for not breast feeding. This kind of non-sense (condescension, lecturing, and ignorance directed at new mothers) is a feminist issue.

I'm sorry that is the case for you. I live in a region that is not only accepting of breastfeeding, but it is highly encouraged. Our pediatrician is wonderful and many of the doctors in his office have special education in breastfeeding (my (medical) nursing expertise is mostly related to people 50+, but as a new parent I'm recalling a lot of what I learned in school!).

It's so important that we take everything with a grain of salt. Advice can be helpful or not, but it's up to us to educate ourselves and make the decisions that are best for our babies. Gather as much information as you can, but use your own best judgment. That's what we did. Great post, Anna.

Oh Anna! This is so true. When I had my son (unfortunately via C-Section), we had a hard time getting together on nursing. We left the hospital three days later with him being down a pound (more than a 10% loss of his birth weight) and me feeling like a failure. The lactation consultant at the hospital was not at all helpful. So, we were told to supplement with formula. A few days later, my husband and I decided to see a private L.C. and she helped tremendously.

My son eventually started gaining weight consistently. But we were still having troubles with nursing. He would have these horrible rages! His pediatrician was convinced he was having reflux problems and gave him two different harsh medications. After about a month, I called another L.C. hotline and they suggested that it wasn't reflux, but that my letdown was too fast for him. All it required was a new position.

I do believe doctors are experts, but they're not experts in EVERYTHING. I feel so blessed to have had these helpful lactation consultants and am still nursing my 15 month old. I feel like it will be much easier to breastfeed (through the good and bad) if my husband and I are blessed with another child.

Anna, would you believe I was once advised to supplement with formula because--ready for this--what would happen if I died, Peapod wouldn't know how to drink from a bottle or like formula. *jaw drops* I'm all for wills, guardianship papers, and life insurance, but supplementing with formula really doesn't rank up there with my "just in case" plans.

Another thing you must also watch for is your own doctor being uninformed. I don't know if you remember the story I shared with you over email, after my last pregnancy loss, about the doctor who told me to wean Peapod to take the medicine he prescribed me, rather than his writing a RX for a nursing safe medication. I had to do my own look up of the drugs in Dr. Thomas Hale's lactation pharmacology book and call up a pharmacist friend to have them insist the doctor give me a medication that was much safer. Advising me to wean my daughter due to a three day antibiotic round was an outrageous request.

I am sorry that there are a lot of doctors that do such things to women who are trying to breastfeed. My midwife and doctor did everything in their power to try and help me breastfeed my daughter but, sometimes it is necessary to use formula.... when my child was 3 months old she had lost almost 3 pounds, showed signs of a failure to thrive, and cried constantly during and after nursing. I used Doctors and a lactation consultant, along with a diet and natural tea plan to help my little one. But, eventually had to make the tough choice to use formula. Breastfeeding should be the first and only choice, but sometimes Moms must make a difficult decision. So let us try and be gracious to them as well. Here's praying to be able to breast feed next time :) :)

The variety of advice these days is so confusing. I am still breastfeeding my 14 month old son. However, he has had issues with gaining weight since ~9 months. During the 6-12 month period I was following La Leche League's advice to nurse first and then offer solids if baby still seems hungry and that solids are mostly for 'fun' at this stage. My pediatrician kept telling me he wasn't getting enough solids and that is the reason for the improper weight gain. (He was also anemic at this time.) This always confused me as the advice seemed to conflict. Now at 14 months, I feel pressure to give up breastfeeding again because it is difficult to get an accurate calorie count while breastfeeding. But I was trying to continue a little longer as my son has some food allergies. I may email you Anna for some advice as it is hard to find a vegetarian breastfeeding friendly nutritionist and I feel so lost! ~Erica

"Advising me to wean my daughter due to a three day antibiotic round was an outrageous request."

Indeed!

Walters Inc,

I hope to be the last person to say anything offensive to mothers who, for whatever reason, had to stop breastfeed and/or couldn't breastfeed at all. I'm sure each mother does the very best she can, at that point of time, for her child's well-being and no one should be judged for their situation or choices. Here, I simply pointed out that pediatricians should be more educated on the issue of breastfeeding, to help those mothers who want and physically can do it.

Erica,

You are most welcome to email me but remember that I'm very very novice to breastfeeding. But I do believe breastfeeding, at any amount, is good for an older baby even if you don't know exactly how many calories your baby is getting from it. Even if your baby is eating mostly solids, breastfeeding has wonderful immunological, not to mention emotional benefits.

I talked to a grandmother a few days ago who said her daughter had to stop breastfeeding because she "wasn't producing enough milk". Sadly, I hear that reason a lot.

There are excellent books about breastfeeding available. When I was pregnant I studied like I was studying for an exam (a very important one). With knowledge, a new mother can know that, yes, sometimes their newborn wants to nurse all day long. And it's completely normal, not a sign of not enough milk!

When my son was two-weeks-old I was finally diagnosed with an endometrial infection from his birth. I had to take antibiotics for ten days so I reluctantly fed him formula. I pumped four times a day and resumed breastfeeding with no problems.

This post is meant to be enoouraging---I hope it comes across that way. The benefits of breastfeeding are worth so much to both baby and mom! Blessings to all new mommies out there and blessings to you, Anna.

I am hoping to nurse my third baby, due in August. However, I've had no luck with the other two so I don't like my chances. For me, the experience has been the other way around. I have been blasted for bottle feeding and told I'm a bad mom for not nursing (my children were VERY sick nursing).

What I think needs to happen is for midwives, lactation consultants, doctors, nurses and other moms to all be open minded and realize that all moms have a choice, and respect those that make different choices, for whatever reason.

I have a great family doctor, but I was very surprised over his lack of knowledge of all things related to breastfeeding. Thankfully we have a great public health system in my area (in central Canada), and when my daughter was born I attended a breastfeeding support group that met weekly for an hour and a half. I not only gained valuable insight from the other moms that I met (and we discussed far more than nursing!), but we also had access to public health nurses and trained Lactation Consultants. They were so helpful and encouraging, and even now encourage us moms to call whenever we have questions.

My issue was overactive letdown and no one ever mentioned it nor did I come across it in my readings. Not until 2 years later did I hear about it. I had so much milk I could have donated it or been a wetnurse.

My son was a very large baby and exclusively breastfed for a long time. I think the nurses at my pediatrician's office were skeptical that he was only having breastmilk because they would ask me several times if I was supplementing with any food, any food at all.

On the other hand, my daughter was slender. She had, and still at age eight has skinny little legs. I once had a nurse suggest giving her ice cream if I want to fatten her up. Yikes!

Great post, and so true!I'm really big on doing research and handling things on my own, so before I had my daughter, I did as much research as I could on latch techniques, milk supply, etc. I could not breastfeed my daughter until she was 3 days old, due to some health problems she had at birth and having to be kept in the NICU while I recovered from a C-section, but I was absolutely determined. I never bought any bottles or formula, because I didn't want to take the easy way out. I had no other option but to succeed. And I did! It was a rough start, but eventually, even without the lactation consultants help, we got into a great nursing routine. Then at around 7 months, my milk supply was gone. I don't know what happened, but my daughter started losing massive amounts of weight, and I was worried sick about my poor baby, so at 9.5 months, I weaned her and gave her formula. I tried very hard to get my milk supply back, tried nursing more frequently and longer, took fenugreek and drank lots of water, etc. etc. And honestly, I wish I would have tried even harder, but hindsight vision is 20/20! I was blessed enough in this time to have my aunt on call when I needed her (she was a la leche league leader and regional president, and nursed all 8 of her children), and she was the only person I actually called for help... everything else I did on my own, because I knew pediatricians were not very educated in this department! I'm very glad I educated myself though, and I highly recommend that every mother do their OWN research, and do NOT rely on the misinformation of pediatricians on this subject.

I also experienced the same lack of knowledge here in Canada last year when I gave birth for the first time. I'm thankful for supportive family members who encouraged me for the first month of breastfeeding. I love being able to feed my precious baby - it's so special. She's a year old now and I have no plans of stopping anytime soon!

It's unfortunate that in some states here in the U.S., we have "medical professionals" that threaten nursing moms with Child Protective Services if the baby isn't gaining weight according to their formula fed baby growth chart. Some babies are just born small and stay small, but to threaten a nursing mother that they'll report her because her child hasn't hit specific weights according to their charts, all the while totally ignoring genetic history and sibling patterns, is mindboggling scary and absurd. This happened to my best friend and the baby in question was her 8th!!!!

I read somewhere that when breastfeeding the mother passes on all of the pollution in her body to her little one. As I'm not yet married or a mother yet, naturally, this is kind of alarming to me. Is this true? Thanks!

I've never heard about this theory; of course, we don't live in a perfect world, so perhaps some less-than-desired substances might reach the baby through mother's milk, I wouldn't dismiss this option. However, can we really be so naive to think that formula is perfectly clean from any and all harmful pollutants? I don't think so!

You know what just occured to me? We live in such a strange world. Well-fed (maybe overfed!) women in developed nations are always "running out of milk" and not able to feed their babies well enough. In the Third World, breastfeeding is often a matter of survival, and I don't know any statistics, but having lived in Africa I'm afraid they'd find our inability to produce "enough" milk rather strange. Even a malnurished mother can keep her baby alive with her milk alone--sometimes that's all she has. It is only severe malnutrition or severe trauma that results in a malnourished breastfed baby.

I really think it is our social and medical practices that are the problem, both with birth and breastfeeding. While we have the wonderful benefits of medicine and safe water for formula when we really and truly need them, it seems these things have overwhelmed common sense and age-old woman-wisdom.

When my first son was skinny and throwing up and cranky, *everybody* blamed my milk. *Everybody* insisted that switching to formula and starting solids early would cure the problem. That same milk nourished two subsequent happy babies to butterball proportions. Had I listened to the well-meaning advice with the first one, I would not have trusted my body enough to give my babies that wonderful gift. I would have quit on the first rough night, or the first bout with mastitis. I'm so glad I have an African husband who thinks breastfeeding is awesome and encouraged me and told me to ignore the ridiculous people.

Alicia, please don't listen to such anti-breastfeeding advice (I might even say propaganda)! Breastmilk is the food God made for your (future) babies, and it's absolutely the best thing you can give to a child after love.

The fact is that you are passing on essential immunities when you breastfeed -- your child will be stronger and healthier if you breastfeed. You will be calmer and less stressed, since breastfeeding releases a calming hormone. You and your baby will have a stronger bond. There are dozens of benefits to breastfeeding, and, for a normal healthy mama and baby, NO risks.

I do remember reading that a particular environmental pollutant is passed through breastmilk--but this particular pollutant is basically impossible to avoid. The benefits and immunities that a baby gets from breastfeeding way, way, way outweigh what environmental pollutants might be passed through mom as well.

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Domestic Felicity is the journey of one woman who loves her family and home and seeks to live a simple, peaceful, and purposeful life. It is also a record of my daily experiences and challenges and everything I'm learning as I walk along this path. If you wish to ask or comment about something but want to do it in private, you are welcome to email me.

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I'm a Jewish woman, a wife, a mother, a homemaker. I love everything that has to do with home and family, and enjoy the solitude of my quiet corner, which is located in one of the most beautiful areas of Israel. Our lives are simple, but very full, busy and satisfying. I'm passionate about writing, hand crafts, healthy food, home education and the human connection to land and nature.